Health risks from Japan’s quake–hit nuclear power reactors seem fairly low and winds are likely to carry any contamination out to the Pacific without threatening other nations as per Malcolm Crick, Secretary of the UN Scientific Committee on the Effects of Atomic Radiation.

It won’t be anything like Chernobyl. There the reactor was operating at full power when it exploded and it had no containment. Partial meltdown of the Three Mile Island plant in the United States in 1979 –– rated more serious than Japan’s accident on an international scale –– released low amounts of radiation. Studies showed that the average increase per person in long–term radiation exposure was equivalent to one CT scan.

The WHO said the public health risk from Japan’s atomic plants remains quite low even though the quake and devastating tsunami may have killed over 10,000 people. The Japan Meteorological Agency said that the winds in the area would shift from the south to a westerly blowing from Fukushima toward the Pacific Ocean.

Time is a big help for reducing health risks since many of the most damaging nuclear effects, such as radio iodines, dissipate within hours or days.

Japan has rated the Fukushima accident at four on an international scale –– meaning an accident with local consequences –– against Chernobyl which was worst at seven on the 1–7 scale. Three Mile Island rated a five.

Medifinance Conference On Portfolio Management for Doctors and update on Budget 2011

In a day Long Conference Mr. Subhash Lakhotia, Tax Guru was felicitated with Distinguished Service Award by Dr N V Kamat DHS on 13th March 2011, at Auditorium, Delhi TB Association, Lodhi Road, New Delhi

National News

Non–communicable diseases pose major development challenge

Non–communicable diseases (NCDs) pose a major development challenge to developing countries like India, where the annual loss of household income due to them is estimated to be Rs.1 billion, Shanthi Mendis, Coordinator of the Cardiovascular Program for Prevention and Management of NCDs, World Health Organisation (WHO), Geneva, said on Sunday. Delivering the Prof. M. Viswanathan Gold Medal Oration 2010 under the auspices of the M.V. Hospital for Diabetes, Dr. Mendis said India’s GDP would have been 4–10 per cent higher if not for the catastrophic health expenditure, productivity erosion and impoverishment associated with the four leading NCDs —cardio–vascular disease, cancer, diabetes and respiratory disease. The WHO expert pointed out that NCDs constituted the single biggest cause of deaths, contributing to 60 per cent of all global deaths. Worse still, 90 per cent of premature deaths from NCDs were from low and middle income countries. WHO estimates that by 2015, the number of deaths from the four leading NCDs would increase by 21 per cent in the South Asian region, Dr. Mendis said.

Delivering the second gold medal oration, Shiv Kumar Sarin, Chairman, Board of Governors, Medical Council of India, said transient elastography was emerging as a reliable imaging diagnostic to measure stiffness of liver in evaluation of fatty liver. The stiffer the liver, the faster the shear wave propagates across the site, he said. Earlier, presenting the oration awards, Governor Surjit Singh Barnala called for a comprehensive diabetes care programme to lower the incidence of diabetes. Institutions such as M.V. Hospital and NGOs should evolve programmes from the regional to global levels for the control and prevention of diabetes. Pointing to estimates that the diabetic population in India would increase to 85 million by 2030, the Governor said a burden of such magnitude would have enormous social and financial implication for the country as a whole. (Source: The Hindu, March 14, 2011)

Harvard researchers say we can "catch" obesity from our friends. So can we "catch" healthy lifestyles too?
Scientists at Harvard University say the dramatic rise in adult obesity in recent decades is due, in large measure, to its spread through social networks — including family, friends, co-workers and neighbors. And they say the role social transmission plays in the obesity epidemic has been expanding. The more obese people we know, the greater our chances of gaining weight. Now consider the alarming new statistics on diabetes — a 9 percent national jump since 2008, and a 39 percent jump in pre-diabetes. It makes you wonder. It seems there’s a strong message here that we all must heed — policymakers, industry leaders, the medical profession, educators, community advocates and each of us individually. Let’s face it, 21st–century living is stacked against the average American struggling with weight. Many modern–day jobs are highly sedentary. People struggling to make ends meet have limited time and finances to either exercise or make healthy, home–cooked meals. The temptation of unhealthy food constantly surrounds us. We’re bombarded by a plethora of junk food advertising and fast–food chains strategically located near schools.

Sildenafil may help treat Raynaud’s phenomenon

Sildenafil may help treat Raynaud’s phenomenon, according to a study in Arthritis & Rheumatism.

Olmesartan may help delay kidney disease in people with type 2 diabetes

Olmesartan, a drug normally used to lower blood pressure, may also help protect the kidneys of people with type 2 diabetes, according to research published in the March 10 issue of the New England Journal of Medicine.

The 5–alpha–reductase inhibitors can have sexual side effects that may persist after the drugs are discontinued, according to a new review in the Journal of Sexual Medicine.

IJCP Special

Dr Good Dr Bad

Situation: A patient wanted to know his risk of MI Dr. Bad: What is your BMI? Dr. Good: What is your waist–to–hip ratio?Lesson: In the INTERHEART Study, waist–to–hip ratio was three times more stronger related to risk of MI than BMI.

Make Sure

Situation: A patient with ejection fraction of 20% dies a sudden cardiac death. Reaction: Oh my God! Why was an ICD not put? Lesson: Make sure all patients with ejection fraction less than 35% are put on implantable cardioverter–defibrillator (ICD) unless contraindicated.

An Inspirational Story

(Dr Anupam Sethi Malhotra)

No Admittance

Wishing to encourage her young son’s progress on the piano, a mother took her boy to a Paderewski concert. After they were seated, mother spotted a friend in the audience and walked down the aisle to greet her.
Seizing the opportunity to explore the wonders of the concert hall, the little boy rose and eventually explored his way through a door marked "NO ADMITTANCE." When the houselights dimmed and the concert was about to begin, the mother returned to her seat and discovered that the child was missing.

Suddenly, the curtains parted and spotlights focused on the impressive Steinway on stage. In horror, the mother saw her little boy sitting at the keyboard, innocently picking out "Twinkle, Twinkle Little Star." At that moment, the great piano master made his entrance, quickly moved to the piano, and whispered in the boy’s ear, "Don’t quit. Keep playing." Then leaning over, Paderewski reached down with his left hand and began filling in a bass part. Soon his right arm reached around to the other side of the child and he added a running obligato.

Together, the old master and the young novice transformed a frightening situation into a wonderfully creative experience. And the audience was mesmerized.

Whatever our situation in life and history––however outrageous, however desperate, whatever dry spell of the spirit, whatever dark night of the soul –– God is whispering deep within our beings, "Don’t quit. Keep playing. You are not alone, Together we will transform the broken patterns into a masterwork of my creative art. Together, we will mesmerize the world with our song of peace."

Many couples undergo years of treatment with no success. It is useful to decide when to call off further treatment. Before the couples even think of doing that they should be certain that they are going to the right infertility specialist and centre. Unfortunately in today’s world there are many doctor and quacks who continue to ‘treat’ infertile couples with inadequate knowledge and facilities. However once they have found the right place for treatment, it is important to know when to stop. It has already been mentioned that IUI should be stopped after 6 unsuccessful trials. When it comes to IVF, once we are certain that good embryos have been formed and the endometrium is good, most couples should conceive within 3 attempts. There is no upper limit to the number of trials a couple should give for IVF, but we would not recommend more than 5 trials. If the embryo quality is poor, egg donation, sperm donation or embryo donation should be discussed. For poor endometrium due to endometritis or Ascherman syndrome, surrogacy is the best option. The choice of adoption should also be discussed after reasonable attempts fails to give success.

The Div of Peripheral Vascular & Endovascular Sciences at Medanta – The Medicity Hospital at Gurgaon (National Capital Region) is headed Dr. Rajiv Parakh who after acquiring the Fellowship of Royal College of Surgeons in United Kingdom in 1986, trained in Vascular Surgery in United Kingdom & then returned to India to set up one of the first independent Department of Vascular & Endovascular Surgery in a city hospital in 1990 and was instrumental in starting one of first recognized teaching & training center in Peripheral Vascular and Endovascular Surgery in North India. He has now moved to start the Institute of Peripheral Vascular & Endovascular Surgery at Medanta– The Medicity Hospital, Gurgaon as the chairman of the Division.

When a person does some act due to the direct effect of delusion he suffers from, then he will not be held responsible for that act

Males are the usual sufferers.

The sufferer strongly thinks that his wife is not faithful to him with no basis and is not trustworthy as far as her private life is concerned. She does not love him and has intimate relationship with some other person. Such a person may torture his wife, may kill her or may even himself commit suicide.

Delusion of self–reproach or self criticism: Here, the sufferer unnecessarily censures himself for some imaginary offence or misdeed "committed" by him. In serious cases, the person may punish himself by terminating his own life.

A person may suffer from multiple delusional disorders for a short period say without any other specific mental problem or mental disease.

Delusions, without any doubt, reflect mental abnormality. Hence, they have many legal bearings. When a person does some act due to the direct effect of delusion he suffers from, then he will not be held responsible for that act.

Legal Question of the Day

(Dr M C Gupta, Advocate)

Q. Am I right that if a rape victim comes with the allegation of rape, it is the responsibility of the accused to disprove the allegation.

Ans. No. You are not right. Your statement is diametrically opposite to legal principles. The basic principle of law is that it is for the complainant to prove the allegation. While it is so both in civil and criminal law, the standard of proof required is more rigid in criminal law than in civil law. Rape cases are part of criminal litigation. It is for the prosecution to prove that the crime was committed. Everybody is supposed to be innocent unless proved otherwise.

Obesity Update

Dr. Parveen Bhatia and Dr. Pulkit Nandwani

Infants of overweight mothers

Congenital abnormalities

Maternal obesity is also a risk factor for congenital abnormalities. An analysis from the National Institute of Neurological and Communicative Disorders and Stroke showed an increase in the incidence of major congenital malformations of 35% when mothers were overweight and of 37.5% when they were obese. The odds ratios for neural tube defects in the offspring ranged from 1.8 to 3 according to the degree of maternal overweight. Obesity is also a risk factor for cryptorchism in male infants.

Prostate specific antigen (PSA) is a protein produced by the prostate, Most of the PSA that the prostate produces is released into the semen, but small amounts are also released into the bloodstream.

Patients with PSA level greater than 10mcg/L are at an increased risk for prostate cancer.

Levels between 4 and 10 may indicate prostate cancer BPH, or prostatitis. These conditions are more common in the elderly, as is a general increase in PSA levels.

The PSA test may be ordered during treatment of patients diagnosed with prostate cancer to verify the effectiveness of treatment and at regular intervals after treatment to monitor for cancer recurrence. Patients with prostate cancer frequently have altered ratios of the two forms of PSA: low levels of free PSA and high levels of cPSA (PSA bound to a protein).

Medi Finance Update

(Dr GM Singh)

Fixed Maturity Income Plan

Where to invest in rising interest rate scenario?

Fixed Maturity Plans (FMPs) provide investors with a good alternative to fixed deposits given that they are more tax efficient. This is especially so during volatile times when investors are likely to be more risk–averse. These schemes are close–ended debt schemes with an objective to seek to generate reasonable returns and reduce interest rate volatility primarily through investment in money market and short–term debt instruments with a maturity profile generally in line with the duration of the Plan.

A meta–analysis of randomized trials found that children with mild to moderate persistent asthma who were treated with inhaled glucocorticoids had better pulmonary function and asthma control than those treated with montelukast.

Latin Quotes

Abeunt studia in mores – Ovid ( Latin)

Use is second nature. (Studies affect the habits and character.) How use doth breed a habit in a man.—Shakespere.

Thought of the Day

(By Dr GM Singh)

One nation, one vision, one identity, one e–medinews. Meri pehchan, mera e–medinews.

Readers Responses

Dear KK, the seminar organised on financial matters was excellent, especially tips given by Mr Subhash Lakhotia. I congratulate the emedinews team and suggest to organise these type of seminars at least once in 3–6 month. I suggest a seminar on medicolegal aspects & recordkeeping in practice: Dr V K Goyal

Thanks to Dr. Aggarwal & emedinews. Up till now I was applauding emedinews for the medical information it provided. However, it provided another surprising benefit today. Due to its extensive circulation, one of my old colleagues, Brig. Gidwani, with whom I had worked in same institution almost 28 years back, rang up today from Pune after seeing my mobile number from the information circular of XVIth World Congress of Cardiology & Echocardiography published in e-medinews dated 13th March, 2011. It was a very happy moment to talk to an old forgotten colleague: Dr (Col) SK Parashar.

Public Forum

(Press Release for use by the newspapers)

Mobile phones can spread infections in the hospital

Mobile phones used by hospital healthcare workers are often contaminated with germs, including those that can cause illness in hospitalized patients, said Dr. KK Aggarwal, Padma Shri & Dr. B.C. Roy National Awardee and President, Heart Care Foundation of India.

Quoting a Turkish study published in the BMC journal Annals of Clinical Microbiology and Antimicrobials, Dr Aggarwal said that Dr. Fatma Ulger and others at Ondokuz Mayis University, Samsun, swabbed the dominant hand and the mobile phones of 200 doctors, nurses, and other healthcare staff working in intensive care units and operating rooms and found that 95 percent of telephones were contaminated, often with more than one type of microbe, and often with antibiotic–resistant bacteria.

Potentially serious infectious bugs such as staphylococci were isolated from phones in intensive care units.

Ninety percent of health care workers said they never cleaned their mobile phones. The investigators recommend routine decontamination of mobile phones with alcohol–containing disinfectants.